The nurse is caring for a client with a history of chronic obstructive pulmonary disease who is receiving oxygen therapy. Which assessment should the nurse prioritize?

Monitor oxygen saturation

Check skin color

Assess for chest pain

Measure blood pressure

Answer and Explanation

The Correct Answer is A

Choice A reason: Monitoring oxygen saturation is critical in COPD, as oxygen therapy aims to maintain saturation (88–92%) to prevent hypoxia. Pulse oximetry ensures adequate oxygenation, guiding therapy adjustments, making it the priority assessment to prevent respiratory failure and optimize lung function.

Choice B reason: Checking skin color assesses cyanosis but is less precise than oxygen saturation. Pulse oximetry provides objective data on oxygenation in COPD, guiding oxygen therapy, making it the priority over subjective visual assessments, which are secondary to quantitative measures.

Choice C reason: Assessing chest pain is relevant for cardiac issues but not the primary concern in COPD oxygen therapy. Oxygen saturation directly evaluates therapy effectiveness, preventing hypoxia, making it the priority assessment to ensure respiratory stability in chronic lung disease.

Choice D reason: Measuring blood pressure monitors cardiovascular status but is secondary to oxygenation in COPD. Oxygen saturation is critical, as hypoxia exacerbates respiratory distress, requiring immediate assessment to adjust oxygen therapy, making it the priority over hemodynamic evaluations.

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Correct Answer is A

Explanation

Choice A reason: Limiting potassium-rich foods is critical in chronic kidney disease, as impaired renal excretion causes hyperkalemia, risking cardiac arrhythmias. Foods like bananas and oranges are restricted to maintain safe potassium levels, making this the priority dietary teaching to prevent life-threatening complications.

Choice B reason: Increasing protein intake is inappropriate, as chronic kidney disease requires protein restriction to reduce uremic toxins and kidney workload. Potassium restriction is prioritized, as hyperkalemia poses an immediate cardiac risk, making it the essential dietary focus over protein adjustments.

Choice C reason: Restricting carbohydrates is not standard in chronic kidney disease unless diabetes is present. Potassium restriction is critical, as elevated potassium levels from impaired renal clearance cause arrhythmias, making it the priority dietary intervention to ensure cardiac safety.

Choice D reason: Encouraging high-sodium foods is incorrect, as sodium restriction prevents fluid retention and hypertension in chronic kidney disease. Potassium restriction is the priority, as hyperkalemia directly threatens cardiac function, making it the essential dietary focus over sodium concerns.

A. Age over 40 years B. Daily walking 2 to 3 miles C. Low-fat diet D. Male gender

Correct Answer is A

Explanation

Choice A reason: Age over 40 increases cholelithiasis risk due to reduced gallbladder motility and increased bile cholesterol saturation, promoting gallstone formation. Aging alters bile composition, with higher lithogenic potential, making older adults more susceptible to cholesterol gallstones, a primary type in Western populations.

Choice B reason: Daily walking of 2 to 3 miles reduces cholelithiasis risk by promoting physical activity, which enhances gallbladder motility and reduces bile stasis. Exercise lowers cholesterol levels in bile, decreasing stone formation, making this a protective factor rather than a risk.

Choice C reason: A low-fat diet decreases cholelithiasis risk by reducing dietary cholesterol intake, which lowers bile cholesterol saturation. This promotes healthier bile composition, reducing the likelihood of cholesterol gallstone formation, making it a protective dietary habit rather than a risk factor.

Choice D reason: Male gender is associated with a lower risk of cholelithiasis compared to females, who have higher estrogen levels that increase bile cholesterol. Men have less lithogenic bile, making gender a protective factor, not a significant risk, unlike age-related changes.

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The nurse is caring for a client with a history of chronic obstructive pulmonary disease who is receiving oxygen therapy. Which assessment should the nurse prioritize?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client with a history of chronic kidney disease. Which dietary restriction should the nurse emphasize?

Correct Answer is A

Explanation

The nurse is reviewing risk factors for cholelithiasis in a client’s history. Which factor most significantly increases the client’s risk for developing gallstones?

Correct Answer is A

Explanation

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